Hydrocortisone in Septic Shock: Continuous Infusion and Bolus Dosing Yield Comparable Blood Sugar Results, reveals study

The researchers demonstrated that continuous infusion and bolus dosing of hydrocortisone have similar effects on blood glucose levels in patients experiencing septic shock. The findings were published online in the Indian Journal of Critical Care Medicine on July 11, 2024.

Corticosteroids are advised for use in adult patients with septic shock who need vasopressors to maintain blood pressure. However, this treatment can increase the risk of hyperglycemia, which is linked to worse outcomes. Considering this, Rashmi Salhotra, Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India, and colleagues conducted a prospective randomized study to compare the effects of continuous infusion versus bolus hydrocortisone on blood glucose levels in patients with septic shock.

Forty adult patients with sepsis and septic shock who required vasopressor support were randomly assigned to either group C, receiving a continuous infusion of hydrocortisone at 200 mg/day, or group B, receiving intermittent bolus doses of hydrocortisone at 50 mg IV every six hours.

The study compared several factors, including blood glucose levels (the primary objective), the frequency of hyperglycemic and hypoglycemic episodes, daily insulin requirements, the incidence and time to shock reversal, and the nursing workload involved in maintaining blood glucose within the target range of 82-180 mg/dL.

The study led to the following findings:

• The average blood glucose levels were similar between the two groups, with group C at 136.5 ± 22.08 mg/dL and group B at 135.85 ± 19.06 mg/dL.
• Additionally, the number of hyperglycemic and hypoglycemic episodes, daily insulin requirements, and nursing workload were comparable across the groups.
• Shock reversal occurred in 35% of patients in the continuous infusion group and 60% in the bolus group.
• The time to shock reversal and the duration of ICU stay were also statistically similar.

"Based on these findings, we conclude that continuous infusion and bolus dosing of hydrocortisone have similar effects on blood glucose control, insulin requirements, and the incidence of hyperglycemic and hypoglycemic episodes. Additionally, both treatment regimens are comparable regarding nursing workload, time to shock reversal, ICU mortality, and length of ICU stay," the researchers wrote.

Adding that, "However, the shock reversal rate appears to be clinically higher with the bolus regimen compared to the continuous infusion. Therefore, further studies to investigate this difference may be warranted."

Reference:

Salhotra R, Sharahudeen A, Tyagi A, Rautela RS, Kemprai R. Effect of Continuous Infusion vs Bolus Dose of Hydrocortisone in Septic Shock: A Prospective Randomized Study. Indian J Crit Care Med 2024;28(9):837-841.